Benadryl (diphenhydramine) dementia link

Birdies

My mom took Benadryl nightly for almost 20 years to help her sleep.  She took 25mg per night for most of those years, then upped the dose to 50mg before she’d stopped taking it altogether in 2016 (at my urging). 

My mom had started showing MCI in 2010, very subtle - but when looking back I recall seeing some changes.

There are published studies that are showing a direct link with Benadryl, which is an anticholinergic drug, and dementia.

Anticholinergic drugs block the action of acetylcholine.  Acetylcholine is needed for sending signals to other cells affecting muscle contraction, learning and memory. 

I believe that my mom’s dementia is related to her long term use of diphenhydramine.

I am curious if anyone else’s LO’s used Benadryl (diphenhydramine) or any other anticholinergic drug long term?

Anticholinergic drugs are used for many conditions including:

over active bladders, COPD, allergies/asthma.

Diphenhydramine is in almost all over the counter PM sleep aid/pain relievers.

 https://health.clevelandclinic.org/do-certain-medications-increase-dementia-risk/

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353

RIM

I was giving my 94 year old father NyQuil.  He has MCI and I did notice a decline in cognition in 5 to 6 weeks that he was taking the NyQuil.  I first noticed a problem with his sleep.  He has severe sleep apnea, which is very effectively treated with a cpap machine.  His sleep was getting very disturb, according to his monitoring software, I didn't know the reason, then I determined the only change was the cough medicine and it had Benadryl mixed in.  I stoped the NyQuil and his breathing and cognition completely normalized.  

The Benadryl definitely disturbed his breathing during sleep and his cognition.

In addition, anticholinergic medicine (metroponol and warfarin) contributed significant memory loss and confusion. 

My father recovered completely after these substances were stopped. 

OnlyChild1970

Wow....a little lightbulb just went on over my head!!

So my mom was on warfarin for ages (Afib, heart disease, valve surgery, etc.). Starting this past October, after the initial injury that set off her decline (a broken toe, then an exacerbation of her COPD leading to a buildup of fluid around her lungs, leading to a 4-day hospitalization after which she declined precipitously) on two occasions when she had her prothrombin time test, it showed that her blood was too thin--therefore, too much warfarin in her system. She'd lost a lot of weight, for one thing, and then the doctors were having problems stabilizing her dosage, so the decision was made to try Eliquis instead of warfarin. That was in January.

Since she's been off the warfarin, her cognition has improved--although that could ALSO be due in part to the sertraline, which has at least let her anxiety subside enough for her to be functional. I thought that was the main issue. But now, having read about the effects of anticholinergic meds, NOW I'm wondering how much the warfarin was contributing to her confusion.

I wonder if there are any other anticholinergics in her box-o-meds. I'm going to have to take a look at that.

mommyandme (m&m)

My mother’s neurologist told me never never give mom Benadryl.   When she had an itching problem he prescribed something completely different.

Marta

Only Child:  to clarify, warfarin is not an anticholinergic medication.  You are thinking of anticoagulant medication.

Anticholinergic meds are those that block acetylcholine, a neurotransmitter that is low in Alzheimer's, and which we try to INcrease with donepezil, rivastigmine, and the like (these are acetylcholinesterase inhibitors).

Examples of anticholinergics include meds for glaucoma, for over-active bladder, for COPD (inhalers), and meds containing diphenhydramine.

OnlyChild1970

Interesting. RIM, above, listed warfarin among the list of anticholinergic medications. Glad it's not so.

RIM

Warfarin is an anticoagulant (aka blood thinner).  It protects against a stroke, the possible effect from AFIB.  My father has a replaced heart valve and also has AFIB.  To treat the AFIB, his metoprolol was increased from a small dose to a high dose.   At a high dose, the metoprolol caused memory loss and confusion/delirium.  Metoprolol is an anticholinergic.  When the metoprolol was stopped, the side effects subsided.  

At a standard dose, Warfarin caused memory loss, confusion/delirium.  Warfarin was stopped, Xerelto was substituted.  When Warfarin was stopped, the memory loss and confusion/delirium subsided.  Warfarin is classified as an anticholinergic.

 http://www.acbcalc.com

Marta

To clarify again:  metoprolol is a beta blocker rather than an anticholinergic.

Wouldn't want people to stop giving their loved one metoprolol (so many people take this) because they thought it is an anticholinergic and making the dementia worse.  Metoprolol is a life-saving drug for many.

Metoprolol is not listed as an anticholinergic drug in the reference cited.  Warfarin is not an anticholinergic and it is not listed in the reference cited.

Please, if you are making declarations of facts in this forum, check them.

RIM

https://www.health.harvard.edu/newsletter_article/anticholinergic-cognitive-burden-scale

Read thru the above link. And see what you think.  

Marta

I do not subscribe to the Harvard Letter.

I do subscribe to the Prescriber's Letter, as I am a prescriber.

JDancer

I  believe that some drugs that are not classified as anticholinergics may have some anticholinergic properties. Do you agree, Marta?

I also think it is very dangerous to adjust medications without good information.

Marta

Agree 100%.

JDancer

Thought about this while cleaning the house. Could the anticholinergic effect be the reason why many geriatrics have trouble with anesthetics (etc.) during surgery and/or opiates...Next time I'm at work (as a nurse) I'll do some research on the hospital's MicroMedex website. This thread is food for thought.

7 years ago I had chemotherapy and was pre medicate with Benadryl (Decadron and Pepcid) before each treatment. I called the Benadryl my "nap in a bag." I had never taken it before and had no idea it would make me sleep. Since then , I occasionally use it as a sleep aid. I may have to rethink that.